Hemobilia in a child due to right hepatic artery pseudoaneurysm: Multidetector-row computed tomography demonstration

Abstract

We present a case of a 12-year-old boy who developed upper gastrointestinal bleeding in the form of hematemesis and melena 1 month after blunt trauma to liver. Computed tomography (CT) angiography with multidetector-row CT demonstrated pseudoaneurysm of right hepatic artery related to old liver laceration to be the cause of the bleeding. Pseudoaneurysm was resected using the roadmap provided by CT angiography findings.

Embolização arterial no tratamento de hemobilia pós-trauma hepático: relato de caso

“…Hemobilia occurs in 2.5% of accidental hepatic traumas and in 3% to 7% of incidental hepatic traumas, and its onset may be observed several months after the trauma (4,5) . The clinical presentation of this condition is characterized by jaundice (60%), right hypochondrium pain (70%) lithiasis, inflammation, vascular malformations and tumors.…”

“…In major bleedings, it is necessary to perform angiography with selective catheterization and embolization of the bleeding vessels. Most frequently, the underlying cause for post-traumatic hemobilia is a pseudoaneurysm (5) . The definitive treatment may include liver resection, ligation of the bleeding vessels or hepatic artery embolization (5,6,8) .…”

Massive hemobilia in childhood

“…Magnetic resonance imaging (MRI) is the first choice in suspected cases of hemobilia, especially in childhood. Magnetic resonance cholangiopancreatography (MRCP) findings demonstrate gallbladder hemobilia as a mixed signal intensity that is consistent with blood products in various stages of breakdown [42][43][44][45][46] . A radionuclide "tagged" red cell scan will be positive for a biliary source if the hemorrhage is brisk.…”

“…Selective arterial angiography is helpful in identifying the source of gastrointestinal hemorrhage; it may provide detailed information of the bleeding, but is less appropriate as an initial screening method. Angiographic video seen in hemobilia cases is a classic depiction of a fistulous communication between the cystic artery and the gallbladder/common bile duct lumen [42][43][44][45] . Magnetic resonance imaging (MRI) is the first choice in suspected cases of hemobilia, especially in childhood.…”

“…When the patient is hemodynamically stable, an upper endoscopy is necessary to identify blood at the ampulla of Vater to confirm a diagnosis of hemobilia and to exclude more common causes of upper gastrointestinal bleeding. The classic endoscopic observation is blood coming from the duodenal papillae; this finding is a diagnostic tool in hemobilia [43,45] . Endoscopy may also demonstrate a duodenal ulcer with a blood clot.…”